Wednesday, 29 August 2012

Men's increasing trend!

I love looking after problem skin!

Lately I've noticed that an increasing number of men are attending our medispa for medical advice related to their skin concerns.

Here's an example of a young man who attended for advice on his acne problems:

Above is the baseline image.

Below is the follow up image, just 4 weeks later!

Happy patient, happy doctor!

Here's another example of a young man who wanted to his cheeks filled, but was advised to fill his jawline at the same time (to prevent looking too feminine!):

Image above is client before filler injected to cheeks and jawline.
Image below is same client 2 weeks after treatment.

Men are definitely catching up with the non-surgical trends sweeping the world..and is it any wonder? Just like women, they also want to look their best.  But there are definitely some pit falls for anyone who thinks that men should be injected in the same way as women..they really do have specific needs to retain a masculine appearance in general!

Wednesday, 1 August 2012

Not every red facial rash is Rosacea!

The other day I met a man who came in requesting treatment of his "rosacea" with laser...he'd already been to a well known laser clinic and been diagnosed with the rosacea by the nurse/laser therapist.

Here's his baseline pic:

He was therefore quite surprised to hear that I completely disagreed with the 'diagnosis'..and that the treatment for his condition isn't with laser rejuvenation, but that it would actually respond to topical antifungal preparations.

So, what's the problem?

This is actually a quite severe case of seborrhoeic of the most common skin and scalp complaints around.
Seborrhoeic dermatitis typically causes a scaly scalp..also known as common dandruff.  But if left untreated for years, as in this case, it will spread onto other areas..usually the eyebrows, central face and sometimes into the outer ear canals.
This patient actually had seborrhoeic dermatitis so badly that it had extended throughout his entire beard area too.

How do I know that this is seborrhoeic dermatitis rather than rosacea?
Well, the two conditions really don't look alike...
Seborrhoeic dermatitis causes a scaly rash, rosacea doesn't.  The rash of rosacea is typically pustular and telangectactic, without any involvement of the scalp for example.

Because this patient has such a chronic case of seborrhoeic dermatitis, the chronic inflammation has caused moderately severe redness of the central face, which dramatically improved following treatment only with antifungal cream and shampoo..within just 3 weeks!  Here's the 'after' pic (though I haven't quite finished with him yet!):

Funnily enough, he had only applied the antifungal cream to the cheeks, missing the upper lip scaly areas, so is going to apply to those areas before he returns next!  To help resolve the residual redness on the cheeks a little quicker, I also performed one session of laser rejuvenation (Medicare rebatable too..another win for the patient!) onto those areas that are now clear of fungus at the follow up session.
Needless to say, he is a very happy patient!  Will update this post once I have the updated image from the next review visit.

Lessons from this experience:
If you have a skin complaint, have your rash properly diagnosed by a trained MEDICAL doctor.  Nurses and laser therapists are NOT MEDICALLY QUALIFIED to diagnose, even though they may have been trained to administer treatments!
Laser treatment can be expensive..and a waste of time and money if it is done inappropriately.
We all (unless you're 'lucky' enough to be a 3rd gen family trust baby!) work hard for our income..but having a conflict of interest and performing unnecessary treatments doesn't do your clients or your business reputation any favours!

Thursday, 26 July 2012

Treating the Gummy Smile

Sometimes a smile can reveal a little too much gum line..

Which is why we like to do a little 'magic' (well ok, it's a few injections)...

and freshen up the skin with our prescription formula cream at the same time!

Still you....only better!

Thursday, 19 July 2012

Looking Tired or Drawn? A Unique Volumising Treatment Option

Not every client is looking for an instant or dramatic change.
As cosmetic treatments become more mainstream, enquiries are increasingly coming from those seeking a discrete, gradual change without any of the telltale signs of having had "work done".

In this example, a client who works full-time, and has never had any kind of cosmetic treatment done before, sought advice because she felt "drawn and tired looking".  She specifically stated that she didn't want anti-wrinkle or filler injections.

The perfect solution to this dilemma was found with a liquid that stimulates new collagen production gradually over time.  This product has been around in Australia for over ten years now, and my experience using the product is of a similiar duration.

Using a microcannula to minimise the risk of bruising, I was able to treat this client from her temples to the cheeks and chin area.  We repeated the treatment 6 weeks later, and reviewed her at the 6 month mark to see how she was looking.  The photos speak for themselves.  A very happy client who is now set to maintain the effect with smaller treatments every 2 years or so.
The only additional procedure she has had in the interim period was some laser removal of some pigmented lesions on the R cheek.

This volumising treatment is a much under-utilised treatment option in my opinion, though it must be injected with care and with careful post-treatment instructions.  It is a wonderful treatment option for the older client seeking a discrete and natural looking effect.  It is particularly good for those with low body fat..either through age, genetics or frequent gym workouts.  It will give back the cheek a natural fullness that usually only comes with significant weight gain...but clients must be patient as it can take anywhere from 6 to 12months to have the desired effect.

If you would like to read more about collagen stimulators (& dermal fillers!) please take a look at our Skin Temple website link: Dermal Fillers and Collagen Stimulators

Before and 6 months after 2 volumising treatments

Still you....only better!

Sunday, 20 May 2012

Sunscreen Selection in Australia

With the number of skin cancers diagnosed in Australia almost DOUBLING in the last ten years,  it really is high time that those of us who work in the skincare industry as medical practitioners double our efforts to help guide patients in the selection of appropriate sunscreen.

Choosing an appropriate sunscreen can have both short and long term effects.. I see a lot of clients who report that despite sunscreen use, they sometimes still get sunburnt on a sunny day, and this is an indication that their sunscreen choice or possibly application technique, isn't ideal.  In the long term, this puts them at high risk of unnecessary photoaging changes in their skin (pigmentation, solar elastosis, wrinkles, etc) but also dramatically increases the risk of developing basal (BCC) or squamous (SCC) cell carcinomas, and the frighteningly deadly melanoma.  I've been a doctor for nearly 20yrs now(!) and have met many thousands of people from a wide spectrum of backgrounds, but it seems to me that just about everyone in Australia who grew up in the era pre sunscreen use (1970s) will get a BCC or SCC eventually, and that is even despite many of the baby boomer generation using sunscreen diligently since the late 1970s..when chemical sunscreens really took off.

So what is going on?

Those of you who know me will know how passionate I am about using mineral sunscreen, as opposed to chemical sunscreen.

Mineral sunscreen has been around since...??I'm actually not sure!  Maybe it came in after was definitely used by cricketers in the early 1970s, and I think surf lifesavers in Australia were onto it even well before then.  Anyway, back then it was thick, white or pastel coloured, extremely effective but hard to get off, would stain clothes, and really wasn't cosmetically acceptable for the general population.  It was great to protect one's nose or lips, but you really would never go out in public looking like you had just left a clown audition.

So, along came chemical sunscreen, and much to the delight of the general population, especially the baby boomers who loved the outdoor lifestyle, this was a product that was light, was transparent, easily absorbed into the skin and could even be added to moisturisers or foundations, and best of all, was super cheap to make...a boom industry was born and two of Australia's largest and most successful pharmaceutical companies (Ego and Hamiltons) have ridden on the back of the sunscreen sheep ever since.   They're also really great at promoting their products to Australian general practitioners and dermatologists.  I don't think I've ever seen a dermatology practice that hasn't been brimming over with free samples of chemical sunscreen...or one that had any samples of the mineral variety!

Unfortunately though, the promises made by the chemical sunscreen industry need to be looked at a little more thoroughly than the average person seems to.  I love being the 'sunscreen cop', so here's my list of why I really, really dislike chemical sunscreens:

1.  Many people are highly allergic to chemical sunscreen and will break out into an intensely itchy rash if it is applied anywhere on their skin.
2.  Go swimming with chemical sunscreen on your face and it will sting your eyes in an instant.
3.  This is the really important part of this blog post, chemical sunscreen is almost always PHOTOCHEMICALLY UNSTABLE..which is a technical way to say that it gets degraded by the very thing that it is blocking..UV light.  So, regardless of whether your chemical sunscreen is SPF 15+ or 30+ on the label, the reality is that after just 2 hours of sun exposure, your lovely product has an SPF of 0+, unless you have noticed the small print on the label that tells you to reapply every 2hours!  Oops, you didn't see that?   Maybe you did, but like 99.9% of the people I see, you didn't realise why that was important, and given how impractical such advice is, it really isn't an option for you to do that on a regular basis!
4.  (You didn't really think I had finished my rant did you?) The chemical reaction that the ingredients undergo with UV light, not only consumes the chemical ingredient, but in trapping the UV energy in the product, also creates free radicals on the skin!  Why on earth would someone want to use a product that increases free radicals, when we are so keen normally to remove them via use of antioxidants (either dietary or topically applied)!
It just doesn't sound like a logical thing to use to protect your skin, does it?
5.  Lastly, the SPF rating system only refers to UVB protection, so most chemical sunscreens were developed to protect from UVB, not UVA.  (And by the way, please bear in mind that any cosmetic company can put a SPF15+ rating on any product with a trace of sunscreen ingredient in it without having to prove that it works.  So if you want to know that your sunscreen has been scientifically tested by an independent laboratory, you need to buy SPF30+.)

On the other hand, mineral sunscreens are much better today than they were 40years ago.
Here's my list of why I prefer, use and recommend mineral sunscreens:

1.  They're photochemically stable...meaning they don't need to be reapplied every 2hours.  Unless you're in the surf, running a marathon or have a bad habit of touching or wiping your face, these ingredients will stay on and keep doing their job until you remove them.  If in doubt, reappy once during the day or for prolonged sun exposure.
2.  They're more water won't run into your eyes the moment you put your head under water
3.  They can be readily formulated to be tinted, or virtually transparent these days, making them much more cosmetically acceptable than in earlier years.
4.  They rarely cause allergic's far more likely that a person getting a rash from a mineral sunscreen has a preservative allergy than a true mineral sunscreen allergy.
5.  The spectrum of UVA cover is generally far better than most chemical sunscreens, which usually only cover the UVB spectrum.  Although some newish patented chemical sunscreens from L'Oreal claim to have great UVA protection and to be photochemically stable, these claims remain to be proven, given that no independent laboratory testing occurs on any product with SPF <15+.  Some of these products have already been removed from the market overseas, so it remains to be seen if they will undergo independent scientific verification in Australia.  The well known formulations of La Roche Posay became available in Australia in 2012 and contain the patented Anthelios sunscreen..which is a mix of titanium dioxide and avobenzone.  Avobenzone is a good UVA chemical sunscreen..but is famous for also being extremely unstable on light exposure so requires further chemical sunscreen additives to become stabilised enough for general use.
6.  The mineral ingredients used (zinc oxide, titanium dioxide) are non-patented naturally occuring compounds so they're cheap (but not as cheap as chemical sunscreen), there's lots of scientific research and reviews of these products available. Some research lately has become commercially minded, as the big pharmaceutical companies realise that an increasingly educated public are a threat to their chemical sunscreen profit margins.  Nanoparticle risk?  Scary how much publicity this issue has had when the 'research' into the issue was resoundingly dismissed as inadequate by the Therapeutic Goods Administration.  Nanoparticles have been shown to aggregate and agglomerate when put into a cream carrier.  If 10x nanoparticles join together, as is their natural tendency, they are no longer small enough to be classified as nanoparticles!  That is, they become incapable of penetrating the skin barrier.

I'm not sure about you, but I'd much rather 'risk' using a mineral sunscreen than a chemical one any day!!
And when I hear that the incidence of skin cancer has almost doubled in the last ten years in Australia, I really do think I can understand why that has happened.  I only need to think of all the thousands of men and women I've met who thought they were protected by wearing chemical sunscreen ("every day, doctor"), so went about their happy lives in the great outdoors, not ever reapplying their 'wonder product'.

Monday, 5 March 2012

Have you (or someone you know) had a Laser Disaster?

We love helping fix other people's problems!  And we're not shy to tackle the high risk difficult clients either!

Take this example:
This patient of SouthEast Asian background was severely burnt during a laser procedure undertaken overseas, and was then inappropriately treated after the burn also.  The result?  A severe case of post-inflammatory pigmentation, which took many months of very careful lasering and topical at-home treatment using prescription-only skincare products.
But boy oh boy, does she look better now!



If you've had a terrible laser experience please seek help immediately from a qualified and experienced medical laser expert.  Burns must not be treated in salons by non-medically qualified staff as many of these will require prescription-only treatment.  By acting quickly, you can prevent severe disfiguration that may require multiple costly laser treatments to remove.

Contact Skin Temple by email (only general enquiries will be answered):
Call us for an appointment to discuss your specific problems in person 03 9867 2992.
View our website for further information on the range of services available:
Like us on facebook: and remember to share this post with your friends!

Is Adolescent Acne Getting You Down?

Congratulations on discovering the ‘joys’ of having unpredictable acne problems..just when you least needed to have a crisis of self-confidence!

Acne problems come in all’s not just the obvious cystic acne that needs treatment..even years of blackheads can leave permanent scarring.

There are 3 types of acne lesions:
1)   Non-inflammatory, meaning the acne lesions are mostly just a mixture of white- and black-heads (also known as milia and comedones)
2)     Inflammatory, meaning that in addition to the above lesions there are numerous red angry looking, but non-tender, fairly superficial pimples
3)     Cystic- meaning that in addition to points 1 and 2 above, there are also very red, hardened, tender lumps deep in the skin

Acne forms largely as a result of the hormonal effect on the skin at puberty..all those circulating hormones stimulate oil production enormously, and the oil has an effect on the outer dead skin cells much like ‘glue’ sticks the cells all together and slows down the natural shedding effect of the skin.  This leads to congestion around the openings of the pores, and stagnate oil is a major risk factor for infection setting in.

So, what to do?
Firstly, because acne can vary from person to person, make sure you get prompt advice to minimize the chance of your acne progressing to the most severe forms. 

In the early stage, your local cosmetic physician, chemist or dermal therapist may be able to help out with some simple advice for appropriate skincare containing AHAs or BHAs (these are products containing gentle acids, which work by loosening the build up of dead skin/keratin). Eg ASAP products.  It is important to balance these with some very gentle skincare products, to avoid having your skin become overly irritated or sensitive. Eg Avene products

Here's a before and after of one of my clients with only mild inflammatory acne: 
However, if you have any sign of inflammation at all, you will need to consult a cosmetic physician or general practitioner with an interest in skin to obtain prescription based medication, (eg antibiotic tablet or toner, vitamin A based creams) not available over the counter.  You will almost certainly need to use these as well as an acid based skincare range.  Chemical peeling can also be very useful and rapidly effective for mild-moderate acne.

If your skin doesn’t respond to medical treatment within 3 months (eg a combination of creams and possibly antibiotic tablets or chemical peels), or if your acne problem is in the most severe category, you will need  to be referred to a dermatologist for a medication that is an oral form of vitamin A.
There are numerous brands of iso-tretinoin, such as Roaccutane or Oratane.
Iso-tretinoin works extremely well for severe cystic acne, but can have a lot of side effects (such as birth defects), so must be prescribed and used very carefully.

Diet is important for some people, less so for others.  What’s important overall is to be on the lookout for foods (and drinks eg alcohol) that can precipitate acne breakouts, and avoid these whenever possible.
Stress can be a common precipitant for many people, and learning some healthy techniques for minimizing the impact of stress (eg pre-exam times) can be a useful lifelong measure.

Acne scarring gets many people down, and can be a costly thing to treat with laser.  What’s essential therefore, is to get great advice quickly, and to therefore minimize the chance of needing laser later on.  Some scarring is easily fixed by great skincare advice alone.  
Here's an example of one of my clients with lots of nasty pigmented scars (who hadn't finished treatment when this follow up photo was taken) which have dramatically improved with medical treatment only:

On the other hand, if you leave your cystic acne for too long, even though your skin will look a lot better once the active lesions are controlled, you'll be left with significant scarring that only aggressive lasering can fix.  See another of my client before and afters (this is after medical treatment, not laser!): 

Makeup to school?  That’s ok as a short term thing.. most of us understand what it feels like to have something you’d rather hide on your face! Try to choose a makeup that is oil free, and better still, try one of the mineral powders rather than a liquid foundation..a powder will absorb your excess oil and reduce any shine in the process!  As soon as your acne is under control, ditch the makeup and just use sunscreen every day..much more important for your skin’s long term health!

Controlling oil production isn’t always easy as a teenager.  Be aware that the more you’re tempted to overcleanse your face, making it feel squeaky clean will in fact only stimulate your oil glands to crank up the oil production even more!  Oil is there because your skin needs a certain amount of it to stay healthy, keep out water, bugs and other potentially harmful substances.  If you strip it entirely, your body will try to replace it faster than you realize.  If your pores are blocked, this will lead to cystic lesions forming very quickly.  Use a gentle soap free cleanser once a day, and an acid containing scrub daily also.  You won’t believe the difference it will make!


I started my passion for skincare as a somewhat pimply and sun obsessed 16yo, growing up in country Victoria.  A summer spent frivously working on my tan and observing the scary effect it had on my skin, convinced me of the need to accept the skin colour I was born with, a decision that I am proud of making at such a relatively young age!
Fast forward a number of years, and after graduating from Monash University with honours in 1993, I went on to post graduate studies in General Practice (which showed me how little is taught to GPs about general skincare and especially the non-pharmocological treatment of acne) and obtained a Certificate in Dermatology in 2005. I started my ‘official’ training in Cosmetic Medicine between 2000-2002, including with a Cosmetic Dermatologist between 2001-2002, and then started my first business, Victorian Cosmedic Service, in 2002, opening Skin Temple Medi Clinic and Spa in 2010, and won the Australasian Spa Association award for Best MediSpa only 15months later in 2011. Please check out our website for a full list of treatments available:

Interested in providing cost effective solutions especially in the area of acne management, we pride ourselves on also offering first class skincare education to our clients, which means that our treatment results last far beyond a temporary short term solution to what is often a long term problem.

If you have a general enquiry about our acne services, please email:
Specific enquiries about your acne problems will require a consultation with Dr Teska.  Please call our medispa on 03 9867 2992 to make an appointment.
For further general information on the range of services available at Skin Temple, please view our website: 
Our facebook page is located at: Please like our page and remember to share with your friends!

Sunday, 26 February 2012

Is Vitamin D deficiency the Scurvy of our time?

We're hearing a lot about vitamin D deficiency these days.

Nutritional research is rarely a topic of much interest for the big pharmaceutical companies, but finally there is some research being done that would suggest that vitamin D is a much more important molecule than previously suspected.  A definite association with osteomalacia and rickets, and possibly linked to depression, diabetes, multiple sclerosis and other illnesses, vitamin D research is finally getting the attention it deserves, but at this stage it seems that we are a long way from really understanding what the full effect of vitamin D deficiency is.

Vitamin D is a substance usually made in the skin from the UV light, but there are also dietary sources too, such as eggs and fish, making it quite unlike all the other vitamins.

Unfortunately, this mixture of sources is also affecting scientific research, preventing many studies from having true 'control' groups.
But the biggest problem of all is the lack of consistency when it comes to measuring vitamin D levels in the different laboratories..and we're not talking about the difference between countries.  Unfortunately, even in Australia, there are numerous ways of measuring vitamin D levels from one lab to another. 

 This makes it virtually impossible to compare data or entertain the thought of doing a meta-analysis (where data is pooled from a variety of studies around the world).  And for patients having treatment for Vit D deficiency..let's hope they're not changing labs for their next blood test or the result will be meaningless.
Hard to believe that in this modern age, a lack of consistent analysis and an inability to therefore share information is preventing us from learning about one of the most important vitamins known to mankind.

One hundred years ago, the term 'vitamin' was first coinied by Casimer Funk at the Lister Institute in London.  Vitamins are micronutrients essential for normal cellular function.  They generally fall into 2 groups..the fat soluble (A, D, E and K) and the water soluble (Bgroup, C).  With the exception of vitamin B12, only the fat soluble vitamins can be stored in the body.
Scurvy, due to a severe deficiency of Vitamin C (also known as ascorbic acid), was a common disease affecting the sea-farers of the 16th-19th centuries.  It took more than 300 years for the cure of scurvy to be identified, and even longer for the ultimate cause to be identified (ascorbic acid wasn't isolated until 1932).  In the meantime, countless naval tragedies claimed the lives of millions of men, either directly or indirectly as a consequence of vitamin C deficiency.  Scurvy killed more people than all the storms, shipwrecks, combat and other diseases combined.  Lemon juice rations were used as a means of scurvy prevention by the British during the blockade of Napoleonic France, and thanks to the resultant unusually healthy navy, the British rapidly became the first truly global superpower, able to send large numbers of people to the Antipodes on searoutes that took many months to complete.

How sad then, to discover that the cure for scurvy was actually documented in the early 17th century by a English naval merchant who had grown up in Portugal, recognising the value of lemon juice and going to great lengths to ensure that he always carried it on journeys to the East Indies.  Somehow, this cure was overlooked within 30yrs of its discovery, (perhaps partly because lemon juice was expensive!) and it took another 260years before official instructions re lime juice were issued by the British.

Scurvy is still around today, for it cannot be vaccinated against.  The early signs being that of lethargy and mental more advanced cases dental loss, swollen gums and poor wound healing.  Wherever there is a war, a drought, a famine, a flood, (anything that interferes with normal transport and food distribution networks), the elderly and infirm, or those with imbalanced diets, you can be sure to find scurvy.

The prevalence and incidence of vitamin D deficiency, on the other hand, can only be estimated currently, but it is very likely to be of a much greater magnitude than that of vitamin C deficiency,given our modern lifestyle of working long hours indoors with deliberate avoidance of excessive sun exposure, especially in those trying to limit the cosmetic and medical consequences of a life spent too much in the sun, as our parents often did from the 1950s through to the 1980s.

Let's hope that scientists and governments around the world remember the millions who died unnecessarily from scurvy, and unite in the near future to share data on vitamin D from a universal research method.  For everyone else, please remember that a varied diet, rich in fruit and vegetables, is one of the most important health measures you can do on a daily basis..especially in those over 40!